How the Cycle of Chronic Homelessness Begins—and Ends

Untreated mental illness, addiction, and childhood trauma can spin a life out of control. This is a story about taking it back.

This story is part of a CityLab series on the state of homelessness in American cities. See more of our coverage here, here, and here.

For the nearly two decades that Charles lived on the streets of Washington, D.C., the nation’s elite hustled past him with their eyes mostly averted. They saw only a homeless crack addict, not a man carrying a weight that finally dragged him all the way down.

Today, inside his own clean, white-walled apartment in Southeast D.C.'s Woodland neighborhood, Charles, 51, pulls up a sleeve of his white polo shirt to show me his scars.

The looped extension cord he recalls his mother using to strike him as a child has left a distinctively curled mark. There are slashes, too, which may have come from the belt his father preferred, sometimes wielded by a brother left in charge of “discipline” when their parents were out.

For the adult Charles, who asked that his last name not be used in this article, the emotional scars will always be the deepest: he remembers sexual abuse by a cousin; he recalls watching his alcoholic father beat his mother; he'll never erase the memory of being forced to fight other children for the entertainment of his father's drinking buddies. More than 30 years later, Charles' voice still tightens as he describes the litany of abuse he remembers suffering at the hands of those he loved and trusted most.

No one called the police or Child and Family Services. Neither would have been viewed as agents for good back then in the Lincoln Heights projects of D.C.

If the foundation of a life is laid in childhood, Charles' was built with stones cracked by force. Still, for 27 years, Charles managed to hold himself together.

He had a home, a wife he loved dearly, and two precious daughters. With certification as a special police officer and experience in security, he landed a coveted spot with Georgetown University campus police, which offered his girls educational opportunities beyond anything his salary could’ve afforded.

Then suddenly, a week into training, Charles couldn’t get out of bed. A dense fog had invaded his brain, a pervasive ache infected his body. Insecurity, anger, and despair replaced joy, excitement, and ambition. A psychiatrist could have recognized the clinical signs of depression, but Charles had scant awareness of mental health.

Charles' wife fled their home with their daughters. "And that was like a green light to go mess up my life." He spent all of his money on drugs. Finally, Charles became homeless. It would be 18 years before he wrestled back control over his life.

Charles lost his job and began a bleak march towards self-destruction. Rage suppressed since childhood resurfaced. Home life became less tranquil, yet more familiar. So when a night out with a friend led to a woman with shiny little crystals she said could make him feel better, a desperate Charles tried crack for the first time.

Getting high can’t cure mental illness, but self-medicating can instantly obliterate worldly concerns with a power that feels like a cure, however fleeting. Crack did that for Charles. He needed that "cure" again. And again and again and again.

At home, Charles turned into his father—an angry, abusive addict. His wife soon fled with their daughters. “And that was like a green light to go mess up my life,” he says. He spent all of his money on drugs and was evicted from their home. Finally, Charles became homeless. It would be 18 years before he wrestled back control over his life.

He couldn't receive help unless he quit crack, but he couldn't quit crack without help.

During the years Charles lived in an alley behind a CVS in Dupont Circle, abstinence from drugs and alcohol was a prerequisite for homelessness assistance programs. He couldn’t receive help unless he quit crack, but he couldn’t quit crack without help.

But over the past decade, there’s been a push toward a revolutionary shift in thinking about how to solve chronic homelessness, which is federally defined as being without housing for more than a year or experiencing four or more episodes of homelessness over three years.

With help from Pathways to Housing DC and the Housing First model, Charles has gotten the consistent help he needed to address his mental-health and substance-abuse problems, and now lives in his own apartment. (Christina Davidson)

The Housing First model does precisely what its name suggests, providing people with housing before anything else, so that they can then begin to address the underlying issues that led them into homelessness. Pioneered in the 1990s by Sam Tsemberis, a psychologist in New York City and the founder of Pathways to Housing, the model earned federal support under the Bush Administration after data showed that the approach resulted in significant cost-savings.

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Most significantly, Housing First eliminates criminal justice costs generated by punishing the chronically homeless for lifestyle crimes like loitering, and reduces health care costs by creating medical and psychiatric options that don’t involve hospital visits. One study that examined public expenditures in Seattle determined that Housing First saved taxpayers an average of $2,449 per month per person housed under the program.

In 2005, Utah deployed Housing First statewide in a strategic plan to end chronic homelessness within its borders; the current trajectory suggests that they may actually succeed. Utah’s 2014 Comprehensive Report on Homelessness announced the initiative has achieved a 72 percent reduction so far.

Still, universal adoption of the approach remains hindered by a lingering perception that people dependent on drugs and alcohol are undeserving of public assistance. Christy Respress works to combat that mindset in her position as executive director of Pathways to Housing DC, the nonprofit that supports Charles’ recovery from chronic homelessness.

"While we continue to seek out the newest and best treatments for mental illness and addiction, we do know the cure for chronic homelessness: It's housing, first."

“Mental illness, addiction, and homelessness do not discriminate. Each of these challenges could happen to me, you, any of us,” she says. “While we continue to seek out the newest and best treatments for mental illness and addiction, we do know the cure for chronic homelessness: It's housing, first.”

Respress emphasizes, however, that the cure does not stop with the provision of housing. A seven-person support team, including a psychiatrist and nurse, greets every new arrival to Pathways and conducts a comprehensive assessment to develop recovery programs tailored to each individual’s specific needs. Support services can run the spectrum from arranging acute medical care to assisting with filling out mundane forms, since even the smallest tasks can overwhelm someone who is psychologically fragile. “If people need reminders to take their medication, we can do that,” says Respress.

One key element of the program is asking the clients what they need rather than telling them, Respress explains. Being offered choices, and having those choices honored, can assist recovery by helping restore a person’s sense of dignity and self-respect. And since those who experience chronic homelessness often suffer from chronic distrust, Pathways tries to restore the capacity for trust by refusing to give up on them, no matter how long or jagged their path to self-sufficiency may be. Realistically, many will never become wholly self-sufficient, whether due to physical or mental disabilities, or psychiatric disorders.

*****

Charles joined the program in 2006. He overcame his crack addiction in 2009. In the years between, he fled his apartment and returned to the streets more than once. Trading free housing for homelessness sounds irrational, but after 18 years, life on the streets felt normal. “I’d forgotten how to live, and I didn’t know what to do,” is how he now explains those choices.

Charles has also received job training through Pathways and will work with other people recovering from chronic homelessness. (Christina Davidson)

Every time he ran, Pathways counselors tracked him down and offered to take him home. “They showed me that they cared. That gave me hope. I didn’t have that in my life before,” he says. Their unflagging support eventually cracked his hardened shell. “Once I started allowing people to help me, little by little things started to get better,” Charles says.

The Pathways staff psychiatrist—the first mental health professional Charles had ever seen—diagnosed bipolar disorder and prescribed him medication. The diagnosis was a revelation. No longer was the disintegration of his life rooted in irrepressible rage and an incomprehensible “chaos in my head.” The demon he had been battling since childhood had a name, and it wasn’t “Charles.”

“When I learned what I was fighting, it became a lot easier,” he says. “Once we addressed the underlying problem, the cover-up problem resolved itself.

In hindsight, Charles can recognize his descent into crack addiction was like attempting “to slowly commit suicide without the gun.” After a childhood of violence, he explains, “you’re angry and don’t know why, and you don’t know what to do, so you run, and you use drugs.”

When he was homeless, he spent many sunny days lounging on a blanket in Dupont Circle, “watching everyone functioning, and being sad because I knew there was something wrong inside me, but I didn’t know what.”

"Being on the streets degrades mental health. And the longer they're on the streets, the harder it is to get off."

Now, Charles spends his days making plans: Plans for a future with his fiancée, plans for dinner with his children and grandchildren, plans for a career helping others.

He has been volunteering at Pathways for a while, sharing his experiences with new arrivals, and is on the verge of becoming a professional peer specialist. A framed diploma he earned for completing the first level of training and pre-certification at Pathways decorates the otherwise bare, white walls of his living room. After a six-week course that starts at the D.C. Department of Behavioral Health in January, Charles will be certified to work for other social service agencies in the District.

By far, however, reconnecting with family has been his greatest reward. All four of his kids are flourishing, and have collectively given him 13 grandchildren. He once believed that he wouldn’t hurt his kids if he stayed out of their lives; he now realizes that his absence hurt them in other ways. But they forgive him, embrace him, and offer “overwhelming support.”

When asked if there is anything he wants to say to the general public about the experience of chronic homelessness, he doesn’t hesitate: “Being on the streets degrades mental health. And the longer they’re on the streets, the harder it is to get off.”

“I thought I was going to live on the streets until death, but now I know people love me. And I love myself.”

In southwest Connecticut, the gap between rich and poor is wider than anywhere else in the country. Invisible walls created by local zoning boards and the state government block affordable housing and, by extension, the people who need it.